Brief Rifapentine-Isoniazid Evaluation for TB Prevention (BRIEF TB)

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Incidence of First Diagnosis of Active Tuberculosis, Death Related to Tuberculosis, or Death From Unknown Cause [ Time Frame: From entry to occurrence of event, up to end of follow-up 3 years after last participant enrolled (median follow-up time: 3.3 years) ]

Incidence rate (events per 100 person-years) was estimated, and 95.1% confidence interval used to account for interim analysis of primary efficacy outcome.

Original Primary Outcome Measures ICMJE (submitted: July 26, 2011)

Time from randomization to first diagnosis of active TB [ Time Frame: Measured through participants' last follow-up visit (3 years after last participant is enrolled) ]

Number of Participants With Occurrence of One or More Serious Adverse Events (SAEs) Versus no SAEs [ Time Frame: From entry to occurrence of event, up to end of follow-up 3 years after last participant enrolled (median follow-up time: 3.3 years) ]

Occurrence of any SAE that meets the ICH definition of an SAE

Number of Participants With a Targeted Adverse Event [ Time Frame: From entry to occurrence of event, up to end of follow-up 3 years after last participant enrolled (median follow-up time: 3.3 years) ]

Number of Participants in Each Category of Ordered Categorical Variable Indicating Most Stringent Level of Study Drug Management Due to Toxicity That Was Required Over the Treatment Period [ Time Frame: From entry to end of treatment (up to 8 weeks for Arm A; up to 54 weeks for Arm B) ]

Ordered categories include:

Premature permanent treatment discontinuation

Treatment hold for more than 7 consecutive days

None of the above

Cumulative Incidence of Death From Any Cause [ Time Frame: From entry to occurrence of event, up to end of follow-up 3 years after last participant enrolled (median follow-up time: 3.3 years) ]

Data table estimates for percentage who died by each time point were estimated using Kaplan-Meier at 1, 2, 3, and 4 years post-entry.

Cumulative Incidence of Death Due to a Non-TB Event [ Time Frame: From entry to occurrence of event, up to end of follow-up 3 years after last participant enrolled (median follow-up time: 3.3 years) ]

Mean and standard deviation.
Week 16 samples have not yet been analyzed because the metabolite assay is being validated, and requires submission for approval by the Clinical Pharmacology Quality Assurance Program. Analysis of week 16 samples are anticipated to be available in September 2019.

For Version 2.0 of the protocol only, measured in the first 90 participants randomized to Arm B who enter the study taking EFV and who meet dose timing criteria.
Samples have not yet been analyzed because the metabolite assay is being validated, and requires submission for approval by the Clinical Pharmacology Quality Assurance Program.

Original Secondary Outcome Measures ICMJE (submitted: July 26, 2011)

Occurrence of one or more serious adverse events (SAEs) versus no SAEs [ Time Frame: Measured through participants' last follow-up visit (3 years after last participant is enrolled) ]

Highest reported grade of each new Grade 3 or 4 laboratory value or sign or symptom that is at least one grade increase from baseline for targeted events [ Time Frame: Measured through participants' last follow-up visit (3 years after last participant is enrolled) ]

Ordered categorical variable indicating most stringent level of study drug management due to toxicity that was required over the treatment period [ Time Frame: Measured through participants' last follow-up visit (3 years after last participant is enrolled) ]

Ordered categorical variables include:

Premature permanent treatment discontinuation

Treatment hold for more than 7 consecutive days

None of the above

Time from randomization to death from any cause [ Time Frame: Measured through participants' last follow-up visit (3 years after last participant is enrolled) ]

Time from randomization to death due to a non-TB event [ Time Frame: Measured through participants' last follow-up visit (3 years after last participant is enrolled) ]

Only measured in the first 90 participants who enter the study taking NVP and who meet dose timing criteria

Adherence to TB treatment [ Time Frame: Measured through Week 36 ]

Self-reported number of pills missed since last visit and pill count while on study drug

Antibiotic resistance pattern of Mycobacterium tuberculosis (MTB) isolates in participants who develop active TB [ Time Frame: Measured through participants' last follow-up visit (3 years after last participant is enrolled) ]

Measured in the first 90 participants entering the study taking EFV and who meet pharmacokinetic (PK) analysis dose timing criteria and in the first 90 participants entering the study taking NVP and who meet PK analysis dose timing criteria (may be evaluated only in a subset, e.g., those with very low EFV or NVP levels)

Polymorphisms in host genes involved in metabolism or transport of EFV, NVP, and RPT [ Time Frame: Measured through participants' last follow-up visit (3 years after last participant is enrolled) ]

Cost-effectiveness measures [ Time Frame: Measured through participants' last follow-up visit (3 years after last participant is enrolled) ]

Current Other Outcome Measures ICMJE

Not Provided

Original Other Outcome Measures ICMJE

Not Provided

Descriptive Information

Brief Title ICMJE

Brief Rifapentine-Isoniazid Evaluation for TB Prevention (BRIEF TB)

Official Title ICMJE

Phase III Clinical Trial of Ultra-Short-Course Rifapentine/Isoniazid for the Prevention of Active Tuberculosis in HIV-Infected Individuals With Latent Tuberculosis Infection

Brief Summary

HIV-infected people have an increased risk of developing active tuberculosis (TB). At the time the study was designed, the standard course of treatment for TB was 6 to 9 months of isoniazid (INH).This study compared the safety and effectiveness of a 4-week regimen of rifapentine (RPT) plus INH versus a standard 9-month regimen of INH in HIV-infected people who are at risk of developing active TB.

Detailed Description

The World Health Organization (WHO) estimated that in 2017 there were 10 million new cases of TB, and 1.6 million people died as a result of TB. Among new TB cases, it is estimated that 920,000 occurred in people who were HIV-coinfected, and 23% of TB deaths were among HIV-coinfected individuals. In Africa, TB is the leading AIDS-related opportunistic infection. Latent TB infection occurs when people are infected with the bacteria that cause TB, but they do not have any symptoms of TB infection. Latent TB can develop into active TB, and HIV-infected people have an increased risk of progressing from latent TB to active TB. INH is a medication that is prescribed for people with latent TB to help prevent active TB from developing. The standard INH treatment regimen is 6 to 9 months; a shorter treatment regimen of 3 months of once-weekly RPT plus INH has proven to be as effective and improved adherence. The purpose of this study was to compare the safety and effectiveness of a 4-week daily regimen of RPT plus INH to a standard 9-month daily INH regimen for TB prevention in HIV-infected individuals.

This study enrolled HIV-infected people who did not have evidence of active TB but who were at high risk of developing active TB. Participants were randomly assigned to receive RPT and INH once a day for 4 weeks or INH once a day for 9 months. All participants received pyridoxine (vitamin B6) with each dose of INH to help prevent possible side effects. Study visits occurred at baseline and Weeks 2, 4, 8, 12, 16, 20, 24, and 36. At select study visits, participants had a physical exam, clinical assessment, blood collection, and a chest radiograph or chest computed tomography (CT) scan (if needed). Some participants had their blood stored for future testing. Follow-up study visits occurred every 12 weeks starting at Week 48 and continued for 3 years after the last participant enrolled.

Participants who weighed 30 kg to less than 35 kg received 300 mg once daily (administered as two 150-mg tablets).

Participants who weighed 35 kg to less than 45 kg received 450 mg once daily (administered as three 150-mg tablets).

Participants who weighed greater than 45 kg received 600 mg once daily (administered as four 150-mg tablets).

Drug: Isoniazid (INH)

Participants received one 300-mg tablet or three 100-mg tablets of INH once daily.

Dietary Supplement: Pyridoxine (Vitamin B6)

Participants received 25 mg or 50 mg of pyridoxine, based on the current local, national, or international dosing guidelines.

Participants who received 25 mg of pyridoxine took one 25-mg tablet once daily with INH.

Participants who received 50 mg of pyridoxine took two 25-mg tablets once daily with INH.

Study Arms

Experimental: RPT plus INH Regimen (Arm A)

Participants received RPT (dosage based on their weight), 300 mg of INH, and 25 mg or 50 mg of pyridoxine (vitamin B6) each day during Weeks 1 to 4. During Weeks 5 to 36, participants did not receive any study medications.

Interventions:

Drug: Rifapentine (RPT)

Drug: Isoniazid (INH)

Dietary Supplement: Pyridoxine (Vitamin B6)

Active Comparator: INH Regimen (Arm B)

Participants received 300 mg of INH and 25 mg or 50 mg of pyridoxine (vitamin B6) each day during Weeks 1 to 36.

Tuberculin skin test (TST) reactivity greater than or equal to 5 mm or a positive interferon gamma release assay (IGRA) at any time prior to study entry, OR living in a high TB burden area. More information on this criterion can be found in the protocol.

Laboratory values obtained within 30 days prior to study entry:

Absolute neutrophil count (ANC) greater than 750 cells/mm^3

Hemoglobin greater than or equal to 7.4 g/dL

Platelet count greater than or equal to 50,000/mm^3

AST (SGOT) and ALT (SGPT) less than or equal to three times the upper limit of normal (ULN)

Total bilirubin less than or equal to 2.5 times the ULN

Chest radiograph or chest CT scan without evidence of active tuberculosis, unless one has been performed within 30 days prior to entry

Female participants of reproductive potential must have a negative serum or urine pregnancy test performed within 7 days prior to study entry. More information on this criterion can be found in the protocol.

All participants must agree not to participate in a conception process (e.g., active attempt to become pregnant or to impregnate, donate sperm, in vitro fertilization) while receiving RPT and for 6 weeks after stopping this drug

Female participants who are participating in sexual activity that could lead to pregnancy must agree to use one reliable non-hormonal form of contraceptive while receiving RPT and for 6 weeks after stopping this drug. More information on this criterion can be found in the protocol.

Weight of greater than or equal to 30 kg

Participant or legal guardian is able and willing to provide informed consent

Exclusion Criteria:

Treatment for active or latent TB (pulmonary or extrapulmonary) within 2 years prior to study entry or, at screening, presence of any confirmed or probable TB based on criteria listed in the current ACTG Diagnosis Appendix

History of multi-drug resistant (MDR) or extensively-drug resistant (XDR) TB at any time prior to study entry

Known exposure to MDR or XDR TB (e.g., household member of a person with MDR or XDR TB) at any time prior to study entry

Treatment for more than 14 consecutive days with a rifamycin or more than 30 consecutive days with INH at any time during the 2 years prior to enrollment